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1.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 90-96, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31759889

RESUMO

OBJECTIVE: The aims of the study were the translation and a first reflection of the psychometric properties of the Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multidimensional instrument to measure workload in general practice. METHODS: During April and September 2015, the NASA-TLX was translated and evaluated. For this purpose, a questionnaire composed of the NASA-TLX items and others items related to demographic data, was developed. Postgraduate family medicine trainees and family physicians were then asked to assess patient consultations by applying the questionnaire. The psychometric properties of the NASA-TLX were identified using explorative and confirmatory factor analysis. Reliability was assessed using Cronbach's α. RESULTS: Overall, 16 participants completed 769 surveys after a single patient consultation. The highest average was observed for the item 'mental demand' (mean 6.9 ± 5.4), followed by the item 'effort' (mean 6.6 ± 5.5). Factor analysis revealed a one-factor solution with an explained variance of 56.9 %. The German version of NASA-TLX demonstrated a high internal consistency (Cronbach's α = 0.84). Confirmatory factor analysis showed that there was an acceptable consistency between the expected unidimensional structure and the data. CONCLUSIONS: The German version of NASA-TLX provides preliminary indications of psychometric properties and presents an important tool to evaluate family physicians' workload in direct patient contact.


Assuntos
Medicina Geral , Clínicos Gerais/psicologia , Psicometria , Carga de Trabalho , Medicina de Família e Comunidade , Alemanha , Humanos , Encaminhamento e Consulta , Reprodutibilidade dos Testes , Análise e Desempenho de Tarefas
3.
Sante Publique ; Vol. 31(3): 395-404, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640327

RESUMO

OBJECTIVE: The aim of this research is, on the one hand, to describe the customs and attitudes of Swiss general practitioners (GP) considering cardiovascular risk, and on the other, to put into perspective with the national recommendation Eviprev (summary representations of the primary and secondary preventions recommendations for patients aged between 18 and 70 years old). METHODS: The study was based on an online survey sent to general practitioners belonging to the same research network and who were randomly selected. The sample was made of 200 Swiss GP. This article focuses on the frequency with which GP give advice related to consumption of tobacco and alcohol, exercising and nutrition during a regular meeting with their patient or a first visit. The results were analyzed according to age, sex, linguistic area and the extent to which they lived in a city or in the countryside. RESULTS: Results suggest that the majority (97.6%) of GP show concern about informing patients on cardiovascular risk factors. Nonetheless most of the advice given are usually related to the patient's case and not given in a systematic way. Tobacco addiction is the most systematically discussed theme during a first visit (33.9%), exercise comes second (25.6%), then nutrition (16.1%), and finally alcohol consumption (18.5%). Differences in numbers based on the different languages are little, except dealing with exercise. CONCLUSIONS: Recommendations on prevention are followed by a majority of GP. Improvements could be made considering the training given and the remuneration of these counseling activities.


Assuntos
Atitude do Pessoal de Saúde , Doenças Cardiovasculares/prevenção & controle , Clínicos Gerais/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Suíça , Adulto Jovem
4.
Clin Interv Aging ; 14: 1649-1656, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31571844

RESUMO

Background: Challenges to general practitioners (GPs) as family doctors in Germany are growing because of the demographic situation. Technical assistance systems can improve the care for patients provided by GPs and care personnel to preserve autonomy. GPs are key persons in the health care team to recommend and facilitate access to technical solutions to influence their implementation into their patients' homes. Aim: Explore the general receptiveness of GPs in Germany regarding state-of-the-art and modern assistive technology, as well as their experiences, attitudes and expectations and their training demands. Methods: A cross-sectional survey was conducted among GPs in Germany with a self-developed questionnaire sent by mail. Results: Response rate was 34% (n=194). As expected computers and smartphones are widely used. Data glasses, digital pens and virtual reality and others are often "unknown". Experience with assistive technology was gained with emergency call systems, smart calendars and tablet dispensers. Self-reported receptiveness to use innovative technology is high but knowledge is low. The majority reported lack of access to training and support. The receptiveness for advanced education about technical solutions is high. In free-text response, some communicated their worries about the replacement of human interaction with technology. Conclusion: The survey showed an overall high receptiveness about assistance technology to GPs and strong demands for education and support. Education for GPs need greater efforts to master the process transforming the digital health care provision.


Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais/educação , Equipamentos de Autoajuda , Adulto , Estudos Transversais , Feminino , Clínicos Gerais/psicologia , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Smartphone , Inquéritos e Questionários , Realidade Virtual
5.
Psychiatr Danub ; 31(Suppl 3): 416-417, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488763

RESUMO

OBJECTIVES: We wanted to investigate the patient's expectations on the general practitioner's (GP) responsibilities in screening and follow up of disturbed eating behaviour. Then, we looked for remediation for some of the mentioned shortcomings in family medicine. We also examined if online aid (offered by the non-profit organisation "Eetexpert.be") is already known and used. SUBJECTS AND METHODS: Anonymous patient questionnaires were gathered at 4 treatment centres for eating disorders or were collected with help of the Flemish patients organisation for eating disorders (Vlaamse Vereniging Anorexia Nervosa en Boulimia Nervosa). Later, online enquiries were sent to Flemish GPs. RESULTS: Out of 123 patients responding to the questionnaire, 44 found their GP to have had an important supportive role in their healing process. Active listening and targeted referral were among the most appreciated interventions by those patients. 71 GPs replied the online enquiry. Only 1 out of 5 knew about the free online assistance of "Eetexpert.be". Responders suggested several additional barriers to care. CONCLUSIONS: In Flanders there is a contrast between expectations and needs of patients on one hand compared to the services provided by GPs on the other. Reassuringly, all responding physicians were open to more education and support regarding eating disorder treatment.


Assuntos
Atitude do Pessoal de Saúde , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Clínicos Gerais/psicologia , Preferência do Paciente , Pacientes/psicologia , Inquéritos e Questionários , Bélgica , Clínicos Gerais/educação , Humanos , Encaminhamento e Consulta
6.
BMC Public Health ; 19(1): 1110, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412832

RESUMO

BACKGROUND: Experiencing work-related stress constitutes an obvious risk for becoming sick-listed. In primary health care, no established method to early identify, advise and treat people with work-related stress exists. The aim was to evaluate if the use of the Work Stress Questionnaire (WSQ) brief intervention, including feedback from the general practitioner (GP), had an impact on the level of sickness absence. METHOD/DESIGN: In total 271 (intervention group, n = 132, control group, n = 139) non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers participated in this two-armed randomized controlled trial. The main outcomes were the number of registered sick leave days and episodes, and time to first sick leave during the 12-months follow-up. The intervention included early identification of work-related stress by the WSQ, GP awareness supported by a brief training session, patients' self-reflection by WSQ completion, GP feedback at consultation, and initiation of preventive measures. RESULTS: The mean days registered for the WSQ intervention group and the control group were 39 and 45 gross days respectively, and 31 and 39 net days respectively (ns). No statistical significant difference for the number of sick leave episodes or time to first day of sick leave episode were found between the groups. CONCLUSIONS: The WSQ brief intervention combined with feedback and suggestions of measures at patient-GP-consultation was not proven effective in preventing sick leave in the following 12 months compared to treatment as usual. More research is needed on methods to early identify, advise and treat people with work-related stress in primary health care, and on how and when GPs and other professionals in primary health care can be trained to understand this risk of sick leave due to work-related stress, on how to prevent it, and on how to advise and treat employees at risk. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.


Assuntos
Clínicos Gerais/psicologia , Estresse Ocupacional/diagnóstico , Relações Médico-Paciente , Licença Médica/estatística & dados numéricos , Adolescente , Adulto , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Ocupacional/psicologia , Atenção Primária à Saúde , Medição de Risco , Inquéritos e Questionários , Adulto Jovem
7.
Eur J Gen Pract ; 25(3): 149-156, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31339386

RESUMO

Background: A well-staffed and an efficient primary healthcare sector is beneficial for a healthcare system but some countries experience problems in recruitment to general practice. Objectives: This study explored factors influencing Danish junior doctors' choice of general practice as their specialty. Methods: This study is based on an online questionnaire collecting quantitative and qualitative data. Two focus-group interviews were conducted to inform the construction of the questionnaire to ensure high content validity. All Danish junior doctors participating in general practice specialist training in 2015 were invited to participate in the survey, from which both qualitative and quantitative data were collected. The data was analysed using systematic text condensation and descriptive statistics. Results: Of 1099 invited, 670 (61%) junior doctors completed the questionnaire. Qualitative data: junior doctors found educational environments and a feasible work-life balance were important. They valued patient-centred healthcare, doctor-patient relationships based on continuity, and the possibility of organizing their work in smaller, manageable units. Quantitative data: 90.8% stated that the set-up of Danish specialist-training programme positively influenced their choice of general practice as their specialty. Junior doctors (80.4%) found that their university curriculum had too little emphasis on general practice, 64.5% agreed that early basic postgraduate training in general practice had a high impact on their choice of general practice as their specialty. Conclusion: Several factors that might positively affect the choice of general practice were identified. These factors may hold the potential to guide recruitment strategies for general practice.


Assuntos
Escolha da Profissão , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Especialização/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Currículo , Dinamarca , Educação de Pós-Graduação em Medicina/métodos , Feminino , Grupos Focais , Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Humanos , Masculino , Inquéritos e Questionários
8.
Dis Esophagus ; 32(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31323089

RESUMO

Antireflux surgery aims to improve quality of life. However, whether patients and clinicians agree on what this means, and what is an acceptable outcome following fundoplication, is unknown. This study used clinical scenarios pertinent to laparoscopic fundoplication for gastroesophageal reflux to define acceptable outcomes from the perspective of patients, surgeons, and general practitioners (GPs). Patients who had previously undergone a laparoscopic fundoplication, general practitioners, and esophagogastric surgeons were invited to rank 11 clinical scenarios of outcomes following laparoscopic fundoplication for acceptability. Clinicopathological and practice variables were collated for patients and clinicians, respectively. GPs and esophagogastric surgeons additionally were asked to estimate postfundoplication outcome probabilities. Descriptive and multivariate statistical analyses were undertaken to examine for associations with acceptability. Reponses were received from 331 patients (36.4% response rate), 93 GPs (13.4% response), and 60 surgeons (36.4% response). Bloating and inability to belch was less acceptable and dysphagia requiring intervention more acceptable to patients compared to clinicians. On regression analysis, female patients found bloating to be less acceptable (OR: 0.51 [95%CI: 0.29-0.91]; P = 0.022), but dysphagia more acceptable (OR: 1.93 [95%CI: 1.17-3.21]; P = 0.011). Postfundoplication estimation of reflux resolution was higher and that of bloating was lower for GPs compared to esophagogastric surgeons. Patients and clinicians have different appreciations of an acceptable outcome following antireflux surgery. Female patients are more concerned about wind-related side effects than male patients. The opposite holds true for dysphagia. Surgeons and GPs differ in their estimation of event probability for patient recovery following antireflux surgery, and this might explain their differing considerations of acceptable outcomes.


Assuntos
Fundoplicatura/psicologia , Refluxo Gastroesofágico/psicologia , Clínicos Gerais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cirurgiões/psicologia , Adulto , Feminino , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Humanos , Laparoscopia/métodos , Laparoscopia/psicologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Resultado do Tratamento
9.
BMC Health Serv Res ; 19(1): 486, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307457

RESUMO

BACKGROUND: At the end of life, about 85-90% of patients can be treated within primary palliative care (PC) provided by general practitioners (GPs). In Germany, there is no structured approach for the provision of PC by GPs including a systematic as well as timely identification of patients who might benefit from PC, yet. The project "Optimal care at the end of life" (OPAL) focusses on an improvement of primary PC for patients with both oncological and non-oncological chronic progressive diseases in their last phase of life provided by GPs and health care services. METHODS: OPAL will take place in Hameln-Pyrmont, a rural region in Lower Saxony, Germany. Target groups are (a) GPs, (b) relatives of deceased patients and (c) health care providers. The study follows a three-phase approach in a mixed-methods and pre-post design. In phase I (baseline, t0) we explore the usual practice of providing PC for patients with chronic progressive diseases by GPs and the collaboration with other health care providers. In phase II (intervention) the Supportive and Palliative Care Indicators Tool (SPICT) for the timely identification of patients who might benefit from PC will be implemented and tested in general practices. Furthermore, a public campaign will be started to inform stakeholders, to connect health care providers and to train change agents. In phase III (follow-up, t1) we investigate the potential effect of the intervention to evaluate differences in the provision of PC by GPs and to convey factors for the implementation of SPICT in general practices. DISCUSSION: The project OPAL is the first study to implement the SPICT-DE regionwide in general practices in Germany. The project OPAL may contribute to an overall optimisation of primary PC for patients in Germany by reducing GPs' uncertainty in initiating PC, by consolidating their skills and competencies in identifying patients who might benefit from PC, and by improving the cooperation between GPs and different health care stakeholders. TRIAL REGISTRATION: The study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien; trial registration number: DRKS00015108 ; date of registration: 22th of January 2019).


Assuntos
Família/psicologia , Clínicos Gerais/psicologia , Atenção Primária à Saúde , Participação dos Interessados/psicologia , Assistência Terminal/normas , Assistência à Saúde , Feminino , Medicina Geral , Alemanha , Humanos , Cuidados Paliativos/métodos , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Inquéritos e Questionários
10.
BMC Health Serv Res ; 19(1): 496, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311531

RESUMO

BACKGROUND: Although there is evidence with respect to the effectiveness of Chronic Care Model (CCM)-based programs in terms of improved patient outcomes, less attention has been given to the effect of high-quality care on productivity of patient-professional interactions, especially among frail older persons. The aim of our study was therefore to examine whether frail community-dwelling older persons' perspectives on quality of primary care according to the dimensions of the CCM are associated with the productivity of the patient-professional interactions. METHODS: Our study was part of a large-scale evaluation study with a matched quasi-experimental design to compare outcomes of frail community-dwelling older persons that participated in a proactive, integrated primary care approach based on (elements of) the CCM and those that received usual primary care. Frail older persons' perceptions of quality of care were assessed with the Patient Assessment of Chronic Illness Care Short version (PACIC-S). Productive interactions with general practitioners (GPs) and practice nurses were assessed using a relational coproduction instrument. Measurements were performed at baseline (T0) and 12 months thereafter (T1). In total, 232 frail older persons were participating in the intervention group at T0 and matched to 232 frail older persons in the control group. At T1, 182 persons were in the intervention group and 176 in the control group. RESULTS: Paired sample t-tests showed significant improvements in overall quality of care, the majority of underlying quality of care items, and productive interactions within the intervention group and control group over time. Multilevel analyses revealed that productive interaction with the GP and practice nurse at T1 was significantly related to perceived productive interaction with them at T0, the perceived quality of primary care at T0, and the change in perceived quality of primary care over time (between T0 and T1). CONCLUSIONS: Frail community-dwelling older persons' perspectives on quality of primary care were associated with perceived productivity of their interactions with the GP and practice nurse in both the intervention group and the control group. We found no significant differences in overall perceived quality of care and perceived patient-professional interaction between the intervention group and control group at baseline and follow-up. In times of population aging it is necessary to invest in high-quality care delivery for frail older persons and productive interactions with them.


Assuntos
Idoso Fragilizado/psicologia , Relações Enfermeiro-Paciente , Relações Médico-Paciente , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/terapia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Clínicos Gerais/psicologia , Pesquisa sobre Serviços de Saúde , Humanos , Vida Independente , Masculino , Enfermeiras e Enfermeiros/psicologia
11.
Immun Inflamm Dis ; 7(3): 214-228, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290265

RESUMO

BACKGROUND: Clinicians draw on instructional approaches when training patients with anaphylaxis to use adrenaline autoinjectors, but patient use is poor. Psychological barriers to these behaviours exist but are not considered routinely when training patients to use autoinjectors. Health Psychology principles suggest exploring these factors with patients could improve their autoinjector use. OBJECTIVE: To evaluate the impact of a 90-minute workshop training clinicians in strategies and techniques for exploring and responding to psychological barriers to autoinjector use with patients. Attendees' knowledge, confidence and likelihood of using the strategies were expected to improve. METHODS: Impact was evaluated using a longitudinal mixed-method design. Twenty-nine clinicians (general and specialist nurses, general practitioners, and pharmacists) supporting patients with anaphylaxis in UK hospitals and general practice attended. Self-rated knowledge, confidence, and likelihood of using the strategies taught were evaluated online 1 week before, 1 to 3, and 6 to 8 weeks after the workshop. Clinicians were invited for telephone interview after attending to explore qualitatively the workshop impact. RESULTS: χ2 analyses were significant in most cases (P < .05), with sustained (6-8 weeks) improvements in knowledge, confidence, and likelihood of using the strategies taught. Thematic analysis of interview data showed the workshop enhanced attendees' knowledge of the care pathway, understanding of patient's experience of anaphylaxis as psychological not purely physical, and altered their communication with this and other patient groups. However, interviewees perceived lack of time and organisational factors as barriers to using the strategies and techniques taught in clinical contexts. CONCLUSION: Training clinicians in psychologically informed strategies produce sustained improvements in their confidence and knowledge around patient autoinjector education, and their likelihood of using strategies in clinical practice. CLINICAL RELEVANCE: Exploring psychological barriers should be part of training patients with anaphylaxis in autoinjector use.


Assuntos
Anafilaxia/prevenção & controle , Educação Médica/métodos , Epinefrina/administração & dosagem , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Autoadministração/métodos , Inquéritos e Questionários , Adulto , Anafilaxia/tratamento farmacológico , Educação Médica/estatística & dados numéricos , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Clínicas/psicologia , Enfermeiras Clínicas/estatística & dados numéricos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Médicos/estatística & dados numéricos , Autoadministração/estatística & dados numéricos , Vasoconstritores/administração & dosagem
12.
BMC Health Serv Res ; 19(1): 464, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286960

RESUMO

BACKGROUND: The healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care. METHODS: We carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics. RESULTS: GPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively). CONCLUSION: Delegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.


Assuntos
Medicina Geral/organização & administração , Clínicos Gerais/psicologia , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/normas , Idoso , Estudos Transversais , Dinamarca , Feminino , Clínicos Gerais/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
Trials ; 20(1): 405, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31287011

RESUMO

BACKGROUND: Child and youth mental health problems are leading causes of disability and particular problems in low- and middle-income countries where populations are young and child mental health services are in short supply. Collaborative care models that support primary care providers' efforts to detect and treat child mental health problems offer one way to address this need. However, collaborative care for child mental health can be more complex than collaboration for adults for a number of reasons, including two-generational aspects of care, high degrees of co-morbidity, and variations in presentation across developmental stages. METHODS: The study takes advantage of an existing collaborative care network in Tehran, Iran, in which general practitioners are supported by community mental health centers to care for adult mental health problems. At present, those practitioners are asked to refer children with mental health problems to the collaborating centers rather than treating them themselves. We are conducting a cluster randomized trial in which practitioners in the network will be randomized to receive training in child/youth mental health treatment or a booster training on recognition and referral. Children/youth aged 5-15 years making visits to the practitioners will be screened using the Strengths and Difficulties Questionnaire; those found positive will be followed for six months to compare outcomes between those treated by trained or control practitioners. DISCUSSION: If the trial demonstrates superior outcomes among children treated by trained practitioners, it will support the feasibility of expanding collaborative care networks to include children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03144739 . Registered on 8 May 2017.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Serviços de Saúde da Criança/organização & administração , Serviços Comunitários de Saúde Mental/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Clínicos Gerais/educação , Transtornos Mentais/terapia , Equipe de Assistência ao Paciente/organização & administração , Adolescente , Comportamento do Adolescente , Fatores Etários , Atitude do Pessoal de Saúde , Criança , Comportamento Infantil , Feminino , Clínicos Gerais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comunicação Interdisciplinar , Irã (Geográfico) , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
14.
BMC Health Serv Res ; 19(1): 432, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253146

RESUMO

BACKGROUND: A comprehensive disease management programme (DMP) with a central role for general practitioners (GPs) is needed to improve heart failure (HF) care. However, previous research has shown that GPs have mixed experiences with multidisciplinary HF care. Therefore, in this study, we explore the perceptions that GPs have regarding their role in current and future HF care, prior to the design of an HF disease management programme. METHODS: This was a qualitative semi-structured interview study with Belgian GPs until data saturation was reached. The QUAGOL method was used for data analysis. RESULTS: In general, GPs wanted to assume a central role in HF care. Current interdisciplinary collaboration with cardiologists was perceived as smooth, partly because of the ease of access. In contrast, due to less well-established communication and the variable knowledge of nurses regarding HF care, collaboration with home care nurses was perceived as suboptimal. With regard to the future organization of HF care, all GPs confirmed the need for a structured chronic care approach and envisioned this as a multidisciplinary care pathway: flexible, patient-centred, without additional administration and with appropriate delegation of some critical tasks, including education and monitoring. GPs considered all-round general practice nurses as the preferred partner to delegate tasks to in HF care and reported limited experience in collaborating with specialist HF nurses. CONCLUSION: GPs expressed the need for a protocol-driven care pathway in chronic HF care. However, in contrast to the existing care trajectories, this pathway should be flexible, without additional administrative burdens and with a central role for GPs.


Assuntos
Clínicos Gerais , Insuficiência Cardíaca/terapia , Atitude do Pessoal de Saúde , Comunicação , Gerenciamento Clínico , Feminino , Clínicos Gerais/psicologia , Humanos , Masculino , Pesquisa Qualitativa
15.
BMC Health Serv Res ; 19(1): 434, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253160

RESUMO

BACKGROUND: Rising workload in general practice has been a recent cause for concern in several countries; this is also the case in Norway. Long working hours and heavy workload seem to affect recruitment and retention of regular general practitioners (RGPs). We investigated Norwegian RGPs' workload in terms of time used on patient-related office work, administrative work, municipality tasks and other professional activities in relation to RGPs, and gender, age, employment status and size of municipality. METHODS: In early 2018, an electronic survey was sent to all 4716 RGPs in Norway. In addition to demographic background, the RGP reported minutes per day used on various tasks in the RGP practice prospectively during 1 week. Working time also included additional tasks in the municipality, other professional work and on out-of-hours primary health care. Differences were analysed by chi square test, independent t-tests, and one-way ANOVA. RESULTS: Among 1876 RGPs (39.8%), the mean total working hours per week was 55.6, while the mean for regular number of working hours was 49.0 h weekly. Men worked 1.5 h more than women (49.7 vs. 48.2 h, p = 0.010). Self-employed RGPs work more than salaried RGPs (49.3 vs. 42.5 h, p < 0.001), and RGPs age 55-64 years worked more than RGPs at age 30-39 (51.1 vs. 47.3 h, p < 0.001). 54.1% of the regular working hours was used on face-to-face patient work. CONCLUSIONS: Norwegian RGPs have long working hours compared to recommended regular working hours in Norway, with small gender differences. Only half of the working time is used on face-to-face consultations. There seems to be a trend of increasing workload among Norwegian GPs, at the cost of direct patient contact. Further research should address identifying factors that can reduce long working hours.


Assuntos
Clínicos Gerais/psicologia , Atenção Primária à Saúde , Carga de Trabalho/estatística & dados numéricos , Adulto , Feminino , Clínicos Gerais/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos e Questionários
16.
Geriatr Gerontol Int ; 19(8): 705-710, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237101

RESUMO

AIM: The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany. METHODS: The multicenter prospective cohort Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85+) (AgeQualiDe) was carried out. Individuals were recruited through GP offices at six study centers in Germany (follow-up wave 7). Primary care patients were aged ≥85 years (n = 861, mean age 89.0 years; range 85-100 years). The self-reported number of outpatient visits to the GP was used as the outcome measure. To explore religious and spiritual beliefs, the short form of the Transpersonal Trust scale was used. The presence or absence of 36 chronic conditions was recorded by the GP. RESULTS: Multiple Poisson regressions showed that GP visits were positively associated with the number of chronic conditions (incidence rate ratio 1.03, P < 0.05). TPT moderated the relationship between chronic conditions and GP visits (incidence rate ratio 1.01, P < 0.05). The association between chronic conditions and GP visits was significantly more pronounced when TPT was high. CONCLUSION: Our findings highlight the importance of TPT in the relationship between chronic conditions and GP visits. Future longitudinal studies are required to clarify this subject further. Geriatr Gerontol Int 2019; 19: 705-710.


Assuntos
Clínicos Gerais , Múltiplas Afecções Crônicas , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Qualidade de Vida , Espiritualidade , Confiança , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Alemanha , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Masculino , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
17.
JMIR Mhealth Uhealth ; 7(6): e13199, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31199343

RESUMO

BACKGROUND: Mobile health (mHealth) apps can be prescribed as an effective self-management tool for patients. However, it is challenging for doctors to navigate 350,000 mHealth apps to find the right ones to recommend. Although medical professionals from many countries are using mHealth apps to varying degrees, current mHealth app use by Australian general practitioners (GPs) and the barriers and facilitators they encounter when integrating mHealth apps in their clinical practice have not been reported comprehensively. OBJECTIVE: The objectives of this study were to (1) evaluate current knowledge and use of mHealth apps by GPs in Australia, (2) determine the barriers and facilitators to their use of mHealth apps in consultations, and (3) explore potential solutions to the barriers. METHODS: We helped the Royal Australian College of General Practitioners (RACGP) to expand the mHealth section of their annual technology survey for 2017 based on the findings of our semistructured interviews with GPs to further explore barriers to using mHealth apps in clinical practice. The survey was distributed to the RACGP members nationwide between October 26 and December 3, 2017 using Qualtrics Web-based survey tool. RESULTS: A total of 1014 RACGP members responded (response rate 4.6% [1014/21,884], completion rate 61.2% [621/1014]). The median years practiced was 20.7 years. Two-thirds of the GPs used apps professionally in the forms of medical calculators and point-of-care references. A little over half of the GPs recommended apps for patients either daily (12.9%, 80/621), weekly (25.9%, 161/621), or monthly (13.4%, 83/621). Mindfulness and mental health apps were recommended most often (32.5%, 337/1036), followed by diet and nutrition (13.9%, 144/1036), exercise and fitness (12.7%, 132/1036), and women's health (10%, 104/1036) related apps. Knowledge and usage of evidence-based apps from the Handbook of Non-Drug Interventions were low. The prevailing barriers to app prescription were the lack of knowledge of effective apps (59.9%, 372/621) and the lack of trustworthy source to access them (15.5%, 96/621). GPs expressed their need for a list of safe and effective apps from a trustworthy source, such as the RACGP, to overcome these barriers. They reported a preference for online video training material or webinar to learn more about mHealth apps. CONCLUSIONS: Most GPs are using apps professionally but recommending apps to patients sparingly. The main barriers to app prescription were the lack of knowledge of effective apps and the lack of trustworthy source to access them. A curated compilation of effective mHealth apps or an app library specifically aimed at GPs and health professionals would help solve both barriers.


Assuntos
Clínicos Gerais/psicologia , Aplicativos Móveis/normas , Adulto , Idoso , Austrália , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/normas , Telemedicina/estatística & dados numéricos , Interface Usuário-Computador
18.
J Clin Neurosci ; 67: 114-123, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229424

RESUMO

Objectives of this study were to identify the knowledge and support needs for a wide range of health professions who come in contact with patients with Functional Neurological Disorders (FND) in Australia. Invitations to an anonymous online survey (36 items) were sent to health professionals (practicing in the fields of neurology, psychiatry, psychology, general practice, nursing and physiotherapy) who are involved in the care of patients suffering from FND. Potential participants were invited via professional and hospital databases, advertising in professional newsletters as well as direct emails. A total of 538 health professionals completed the questionnaire. Most participants did not feel well educated about FND with only 14% of General practitioners (GPs) reporting 'good' knowledge. Neurologists, GPs and nurses reported lower clinical interest and greater negative attitude towards FND than psychiatrists, psychologists and physiotherapists. Many health professionals do not feel confident discussing the possibility of a Functional Neurological Disorder with a patient. Seeing more patients per year was significantly correlated with greater knowledge (r = 0.54) and confidence diagnosing (r = 0.49) FND. It was also significantly related to confidence in discussing the diagnosis of FND with a patient (r = 0.44). These factors were not significantly related to years of practice. Although patients suffering from Functional Neurological Disorders are commonly seen by many health professionals in clinic practice, there is little training in this area and self-perceived knowledge in Australia is generally poor. There is, however, clear interest in this area and our findings suggest that improved teaching and education of health professionals about FND and its management could potentially have a significant impact towards better patient care.


Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais/psicologia , Doenças do Sistema Nervoso , Austrália , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
19.
BMC Palliat Care ; 18(1): 51, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238934

RESUMO

BACKGROUND: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. METHODS: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. RESULTS: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. CONCLUSIONS: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.


Assuntos
Medicina Geral/tendências , Clínicos Gerais/psicologia , População Rural , Assistência Terminal/métodos , Adulto , Atitude do Pessoal de Saúde , Feminino , Grupos Focais/métodos , Clínicos Gerais/tendências , Visita Domiciliar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências , Pesquisa Qualitativa , Assistência Terminal/tendências , Austrália Ocidental
20.
BMC Health Serv Res ; 19(1): 403, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221215

RESUMO

BACKGROUND: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. METHODS: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. RESULTS: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. CONCLUSIONS: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02757781 . Registered on 25 April 2016.


Assuntos
Atitude do Pessoal de Saúde , Educação a Distância/métodos , Clínicos Gerais/psicologia , Enfermeiras e Enfermeiros/psicologia , Atenção Primária à Saúde , Adulto , Doença Crônica , Estudos de Viabilidade , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Participação do Paciente , Projetos Piloto , Pesquisa Qualitativa
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